- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $213.80 / $2,754.23 / $4,073.80
| Facility | | $213.80 | $2,754.23 | $4,073.80 |
- Facility/Professional
- Facility
- Modifier
- 50
- Typical Low / Median / Typical High
- $1,479.11 / $1,479.11 / $3,235.94
| Facility | 50 | $1,479.11 | $1,479.11 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $144.54 / $269.15 / $707.95
| Professional | | $144.54 | $269.15 | $707.95 |
- Facility/Professional
- Professional
- Modifier
- 50
- Typical Low / Median / Typical High
- $891.25 / $1,479.11 / $2,818.38
| Professional | 50 | $891.25 | $1,479.11 | $2,818.38 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,344.23 / $4,786.30
| Facility | | $56.23 | $2,344.23 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $331.13 / $812.83
| Professional | | $162.18 | $331.13 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $173.78 / $173.78 / $407.38
| Facility | | $173.78 | $173.78 | $407.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $295.12 / $295.12 / $588.84
| Professional | | $295.12 | $295.12 | $588.84 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $208.93 / $398.11 / $812.83
| Professional | | $208.93 | $398.11 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $131.83 / $186.21 / $3,630.78
| Facility | | $131.83 | $186.21 | $3,630.78 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $331.13 / $407.38 / $562.34
| Professional | | $331.13 | $407.38 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,778.28 / $3,630.78 / $8,511.38
| Facility | | $1,778.28 | $3,630.78 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $154.88 / $338.84 / $741.31
| Professional | | $154.88 | $338.84 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $56.23 / $2,344.23 / $4,786.30
| Facility | | $56.23 | $2,344.23 | $4,786.30 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $162.18 / $331.13 / $812.83
| Professional | | $162.18 | $331.13 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Typical Low / Median / Typical High
- $1,445.44 / $3,548.13 / $8,511.38
| Facility | | $1,445.44 | $3,548.13 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Typical Low / Median / Typical High
- $181.97 / $354.81 / $776.25
| Professional | | $181.97 | $354.81 | $776.25 |